Completed forms can be mailed, faxed or emailed to atxpsychiatry@gmail.com
Forms
Our private pay rates are fees for out-of-pocket expense. This is only applicable if you do not have insurance coverage, or if we are out-of-network with your insurance plan (see below for accepted insurances).
Initial evaluation appointment: $500
Follow-Up Appointments: $175
We do accept insurance. When using insurance benefits, please be prepared to email an image of your insurance card (front and back), so we can ensure that provided services are covered for you.
Prior to your initial appointment, our staff will confirm your insurance benefits with your individual insurance plan and will inform you for what you will be responsible (i.e. copay, deductible, or coinsurance) at the time of your visit. We provide this service as a courtesy to our patients to make your appointment as easy as possible. If we cannot confirm your insurance validity before the appointment, payment in full will be expected at the time of service.
If you would like to check your benefits with your insurance company, call the 800 number listed on the your insurance care and ask your insurance representative to help you determine your benefits for BEHAVIORAL HEALTH and/or MENTAL HEALTH services. The representative will help you determine if you have a deductible, copay, coinsurance or any limits on coverage.
Insurance policies accepted for new patients: Aetna, Blue Cross Blue Shield, Covenant Management Systems, Golden Rule, Oscar, and UnitedHealthcare/Optum Please call the office to check on policies not included in the next section.
Insurance policies not accepted for new patients: Ambetter, Cigna, Humana, Medicaid, Medicare, Sendero, Seton Healthcare, Tricare, and Wellmed.
Due to contract restrictions, we cannot provide "self pay" services to new patients with Medicare or Tricare.
We accept the following insurance plans: Blue Cross Blue Shield, United Healthcare, and Aetna plans.
We are not currently accepting NEW Medicare patients, and we are not accepting Medicaid.
We do not accept single case agreements or other insurance plans not listed.
Private pay rates are fees for out-of-pocket expenses. This is only applicable if you do not have insurance coverage, or if we are out-of-network with your insurance plan (see above for accepted insurances).
Initial Evaluation Appointment: $500Follow-Up Appointment: $175
Please Note: If you are insured with an Out-of-Network insurance carrier, you may opt to utilize our Private Pay Rates, and request a coding receipt to submit to your insurance plan to file a claim for reimbursement with your individual plan.
Prior to your initial appointment, our staff will confirm your insurance benefits with your individual insurance plan, and alert you to your patient responsible portion (i.e. co-pay, deductible, or coinsurance) of your visit. We provide this service as a courtesy to our patients to make your appointment as easy as possible.
If you would like to check your benefits with your insurance company, call the 800 number listed on your insurance card and ask your insurance representative to help you determine your benefits for BEHAVIORAL HEALTH and/or MENTAL HEALTH services. The representative at your insurance company will help you determine if you have a deductible, co-pay, coinsurance or any limits on coverage.